Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 0103301297 | VA |
N | 2081S0010X | Sports Medicine | 0103301297 | VA |
N | 213ES0000X | Sports Medicine | 0103301297 | VA |
Y | 213ES0103X | Foot & Ankle Surgery | 0103301297 | VA |
NPI | 1316476161 |
---|---|
Provider Name | Colby Mussett |
First Address | Gainesville, VA 20155-3831 |
Second Address | Gainesville, VA 20155-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 13/12/2021 |